'AI' Is Supercharging Our Broken Healthcare System's Worst Tendencies

It helps keep doctors treating patients instead of bogged down in documentation and bureaucracy. More time for patients and less stressed-out doctors means better outcomes.

A naïve readthrough would lead one to that conclusion perhaps but the elephant in the room here is capitalism. Pragmatically, any "good enough" solution will be used to replace skilled care to improve patient throughput and thus the bottom line.

That's the problem with healthcare. Due to inelastic demand, it doesn't succumb to market forces the way as other markets. Also in many places you have issues with provider collusion, monopoly, and regulatory capture keeping prices high.

The US is particularly bad in this respect. Market sources only seem to prevail in rare cases - like elective procedures which are not covered by insurance (i.e. laser eye surgery).

It's hard to make decisions based on price when you don't even know the price in many cases before receiving care, and you may not have any choice of provider.

You are assuming over the coming years that most parties so displaced simply shift to other parts of the economy as lucrative and are able to take advantage of those benefits. You are also assuming collusion explicit or implicit and the wealth of remaining buyers doesn't just keep prices high.

EG you you have 100 people who can't afford steam off a hotdog and 100 customers with n units of disposable income per day. You end up with 150 customers who can't afford shit and 50 with 2n units of disposable income. The price was never bounded by the actual cost in the first place so the smaller wealthier clientele leads to higher prices.

One could easily imagine many tens of millions of new poor making much less while prices driven by wealth of other segments of society continues to rise who both have less coming in to pay higher prices.

Meanwhile you have tens of millions of people who are presently create little value NOW whose jobs end up politically difficult to deprecate. You need to have SOME people on your side after all.

I don't see our society being a good one now or in 20 years. There is no political will to do anything hard and a thread of greed, cowardice, anti intellectualism and weakness woven through our society.

The gap between rich and poor is growing at increasing pace, just like the gap between rich and mega-rich is.

If you went completely hungry yesterday, nearly starved to death, but today you get enough calories that you feel less pain so you can at least stand up and walk around a bit, while you watch your brother stuff his face with so much cake he has to puke 3 times to make room for more, to then play frisbee with the rest, what would you think? How it was for you yesterday isn't the standard. How it is for others, today, is the standard. It's about fairness and human dignity, nothing more and nothing less. If everybody was starving, we wouldn't even have a name for it, or a problem with it. It wouldn't be a slight on anyone.

Some people shriek in anguish or sob in darkness, kill themselves, over issues that would be a 2 minute phone call and a check that is 0.0001% of their monthly income for someone else. That's a problem, and that kings used to have less than the average homeless do today doesn't change that, and isn't something capitalism gets to take credit for either. Humans have been inventing and improving things since before history, even animals do it, that's just normal.

I agree with what you're saying here - absolutely, bad medical advice from AI (or anywhere) can cause harm.

What I disagree with is the way that you're drawing the conclusion that there isn't even a valid argument to be made for using AI. To be clear, I didn't say we absolutely should do this - the part of my post you quoted is where I said there's an argument for it (i.e. we should have the discussion and evaluate).

If an AI says take hydroxychloroquine for COVID then absolutely that will cause harm. But that theoretical possibility isn't enough to determine whether an AI should be a source of medical advice - you have to actually evaluate whether/how often it will do that. If .0001% of the time it says to do that and the rest of the time it gives good advice on how to treat COVID at home and what symptoms to look out for that would cause you to need to call an ambulance, then the harms are probably greatly outweighed by the benefits.

This is especially true in the case that I argued - where the alternative is no medical advice, because people don't have access to doctors. Lots of people died at home of COVID when they could have been saved at a hospital - we have to consider what the benefits to them might be in addition to what the detriments of AI giving bad advice could be.

The last thing I'll say is that your position seems to be that if a source of medical advice sometimes gives bad advice, we should not use it. The problem is that based on that position, people should not go to doctors. Doctors are humans who make mistakes - plenty of evidence of that to go around. All of these points that you've made apply to human doctors:

> Giving out wrong information can easily kill people. Or permanently insure them. There's a tremendous amount of harm that can occur if you do things wrong in medicine.

> When you attach "[a doctor] said X" to something, it adds the appearance of authority.

> If you had [a doctor] say "go take hydroxychloroquine for COVID", you'd end up with a lot of people getting harmed

I want to point out that there absolutely were doctors who told patients to take hydroxychloroquine.

This is all to say that I think you have to weigh relative harms and benefits. Should someone with access to top tier medical care get advice from an AI? Almost certainly not. Somebody who has access to no medical care or to the sort of doctor who prescribes hydroxychloroquine? As I said initially, it's not necessarily a hard yes but there is certainly an argument to be made that it's a yes.

That's assuming the extremely broken and frankly incomprehensible American model.

Over in the EU, where most of the healthcare is single-payer (sometimes with optional add-ons/extra payers/private care), cost of care has been growing too. There are simply many more treatments which are available now than before, more tests possible to discover issues, etc. as well as of course the higher life expectancy and higher average age across the board. That doesn't mean improvements shouldn't be undertaken. Such as electronic medical files (which are the norm in multiple EU countries but sadly not everywhere, and not on an EU scale - as born in one EU country and now living in another, it would have been extremely useful to be able to automatically share my childhood records), or maybe ML to do predictions and stuff.

Would you rather be treated in a modern hospital or one from 50 years ago? Would you choose the historical hospital if it charged you the same fraction of median income as it did back then?

A major contributing factor to the lack of realized benefits with electronic health records in the United States is that the interoperability specification, CCDA, is only loosely complied with under the "meaningful use" rule from Health and Human Services. Certification is done on site at the EHR manufacturer, in an environment controlled by the manufacturer. The demonstration of compliance does not have to be done in a default "out of the box" environment, but merely that the system is _capable_ of being configured in a way that allows for emitting standards-compliant CCDA.

In practice, this means that most manufacturers do not build systems that are standards compliant by default, and definitely do not install systems that are standards compliant in their initial configuration. Then, individual healthcare practices add customization on top of that, which further complicates data integration.

Ultimately I believe electronic records are a huge factor contributing to the assembly line like experience of modern health care. I pray that I don't die in a hospital.

Precisely, and for this reason, AI will be the snake oil panacea, just as computerization of records were. Both will be important, but the size of the contract will be based on the "transformative" messaging around the pitch. The real value as you've said will accrue to the consultancies and vendors as it always has, so even without the enormous compute bills for AI tools, prices will keep going up.

Epic is an extremely weird case.

I knew someone who worked at a company that was contracted to be a support provider; they had at least one nervous breakdown.

Also interesting to note that the wikipedia article for the company mentions that in some European countries, moving to Epic was a huge pain that caused doctors stress.

OTOH apparently their actual corporate campus is some whimsical Alice-in-wonderland world with no expense spared.

>I would say all of the intervention by the US federal government has made everything much worse

This is assuming without intervention things would've gotten better. It's entirely possible things would be just as bad as they are, or worse, without said intervention

Lack of timely access to accurate information is and was a huge problem, that can be solved by electronic health records.

Whether or not the currently implementation is worth the cost/benefit ratio is debatable.

I envision a scenario though, where all EHR vendors integrate with Apple/Google, and someone’s phone can give access to their healthcare data, maybe even involuntarily in the event of an emergency.

Yup. I applied for a PM position, within 20 minutes of it going up. Quite a specific one: "'expert level' health insurance system knowledge and experience integrating between multiple EHR vendors and partners'". I have all of this. Have built claims benefits management systems being used by some household names in healthcare. I'm an expert in EPIC, Cerner, ESOsuite EHR systems.

10 minutes later: "we are looking for someone whose skillset and experience better aligns with our requirements and the position".

I guess my resume needed more buzzwords.

This doesn't rule out that there were enough good or "better" applicants that crowded yours out.

Why would a human also not choose a perfect CV over other options. What does this prove about AI.

I'm all for reforms to move towards a more market based system. But one has to recognize that at this point we're nearing a century of anti-market meddling - a quick search says 1943 is when healthcare started getting bundled with employment!

And talking about a "free" market is a red herring. There's no reason to believe that the current industry actually wishes to converge on uniform prices with upfront transparency - they could just start publishing such prices at any time currently, but rather continue to benefit from heavy price discrimination. So getting to a functioning healthcare market would actually take a lot of regulation that actively undoes the cancerous behemoth that's been slowly grown. Try asking any doctor how much something might cost and most of the time they will scoff - the rejection of any market dynamics has become pervasive by the entire system.

Also to have an actual free market we'd need to eliminate things like mandatory pharmaceutical prescriptions and patents, which there is unfortunately very little support for doing.

Is the regulations that are forcing co-pays, networks, obscured pricing? From the outside it sounds like the market doing it's best to extract as much money as possible, with the occasional regulation designed to look like someone is trying to fix the mess with a pretty bandaid (like the recent one on detailed upfront pricing).

Thanks for proving my point.

The answer is not less regulation, it's to have publicly owned healthcare. Those regulations were written in blood.

Also go listen to one of the latest episodes of Odd Lots where they interview Lena Khan about anti-trust. Private equity has been rolling up medical companies for decades, essentially doing things like buying up all the anesthesiology clinics in an area so they can jack up prices. Some of the bloat is due to regulations but a lot of the bloat is due to over-financialized bullshit like private equity buying up providers.

I agree, sounds like their systems are optimizing based on the roll-over limit.

Basically I'm just going back to cash pay and negotiation for everything either before the visit, or at the facility. Then using alternatives to health insurance for the original purpose of insurance (lol), to cover unexpected events.

We were one congressional vote away from a public option for healthcare. Let's not pretend it isn't explicitly one party obstinately refusing to do anything on healthcare and dozens of other issues. The answer isn't to scare our elected reps into doing what is right. It's to stop voting for Republicans.

There's a lot that could be said about how an "anxiety" diagnosis is abused by doctors and insurance companies (especially against women), but in the end it really boils down to one thing:

The medications you're taking should be a determination between you and your Doctor, and not an AI working for your insurance company.